Healthcare Provider Details

I. General information

NPI: 1144072901
Provider Name (Legal Business Name): CHIRICAHUA COMMUNITY HEALTH CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2024
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 S OCOTILLO AVE
BENSON AZ
85602-6406
US

IV. Provider business mailing address

1205 N F AVE
DOUGLAS AZ
85607-1920
US

V. Phone/Fax

Practice location:
  • Phone: 520-586-4040
  • Fax:
Mailing address:
  • Phone: 520-459-3110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: TAMRA V SPRINGER
Title or Position: REVENUE MANAGER
Credential:
Phone: 520-459-3011